What do you do if you don't have confidence in yourself on the job?

Phil: One of the big problems that new grads and actually people who are seasoned clinicians have is that they struggle because they can't get everybody better or they just aren't sure of themselves.  Is there a time in your career where it kind of shifted for you, where you kind of went, maybe I don't have to be perfect?

Jenna:  Yes! I have an answer for this. And I have an answer for this because it's something that even when I get stuck today, I still think about. It still comes to mind.  This was really early in my career, actually, and I was still trying to kind of figure out what I need to do and how I should treat patients.  And I was still nervous every single day that I went into the clinic.  And I remember getting a referral from a doctor, and it said, "Request to see Jenna Gourlay."  And it was a patient with ankle pain, a young dancer.  And one of the doctors had referred her specifically to me.  And I was so excited because I was like, all right.  She's referred just to me. 

I did her evaluation, and I could not figure out why her ankle hurt. I couldn't figure out what was causing it. I did so many different tests.  I looked at so many different things.  And eventually I gave her some things to do at home, and I sent her on her way, and I went back to the doctor, and I said, hey, I know you sent me so and so.  I know you wanted me to figure out what was going on and to help her out.  But I did that whole evaluation, and I really don't think I did the kind of job you wanted me to.  I couldn't figure it out. I gave her some things. I guess we'll see if they help. And he just looked at me, and he smiled, and he's like, oh, I sent her to you because I didn't know what was going on either.  I sent her to you because I figured even if you don't know what's going on, you would try really hard and you would be somebody that I could be confident that if I sent them there, they would do everything in their power to figure it out. 

And at that moment, one, I felt so relieved because it was walking over there was just so defeated, like, oh, I finally get a referral, and I'm going over there, and I'm like, I couldn't help the patient.  And then just hearing from the doctor, I didn't know either one. And then two, that I didn't necessarily have to have all the answers.  I just had to give my very best to try and figure them out.  And it was one of those things that, like I said, I still think about it now.  So when I have a patient in front of me and I don't know what's going on.  I'm kind of scratching my head.  I'm thinking of all these different things.  I think to myself, all right, what can you give in this moment?  And then who can you go to to try and help you with it?  Because, one, we're not alone, and two, we don't all have the answers and we don't need to, which is a pretty cool thing as you go forward.

Phil: For sure. That reminds me, I don't think I had maybe the turning point quite as early as you did there, but I remember it was probably about seven years into my career.  We were working with a group of surgeons, and they were great.  We had great relationships.  And I remember one person that they had sent me with a shoulder problem, and I went up and I was like they called it like, rotator cuff tendonitis or something like that.  I'm like, actually, I think they have a labral tear.  And I was pretty convinced of it, and I went up and the surgeon said, yeah, I thought they might, too.  But I use diagnosis by treatment.  So if the treatment for a rotator cuff tendonitis isn't effective, then we can then go to an MRI for and this wasn't a person that needed surgery.  It was just like, you can treat first.  You don't have to have the definitive diagnosis.  You can treat first, and that will help actually diagnose the patient.  And then the second thing is probably near around that same time, though, was the Selective Functional Movement Assessment, where that, combined with my diagnostic tests and my special tests and evidence-based practice, is going to not let me miss something.  And those two things . . . that I could diagnose by treatment, because if it got better, because I was fixing the impairments, I found through a systematic approach, it gave me a lot more confidence to be able to sit back and go, hey, let's let this play out.